Is There Such a Thing as Unhealthy Exercise?

A new year brings both the opportunity for reflection on the past year as well as a chance to set goals that (we hope) will guide our thoughts, actions and intentions in the future. An overwhelming percentage of New Year's resolutions pertain to diet, exercise and weight loss. In fact, one survey found that three out of the five most common American resolutions involve these appearance-centric goals.

In general, goals for improving the physical self through exercise begin as healthy pursuits. However, for a subset of the population, these resolutions -- exercise alone or exercise combined with dieting -- can spiral into something very unhealthy: compulsive exercise. Also known as "over-exercise," this term refers to performing too much exercise motivated by an urgent, compulsive need for movement.

The notion of exercise as being unhealthy is difficult for many Americans to understand: Our culture sends strong messages telling us that exercise is "good" for us. In light of this pervasive cultural sentiment, how do we define and identify unhealthy exercise?

At a very basic level, we can look at quantitative measures, including frequency of exercise and the intensity of the movement. We can also examine the physical repercussions of over-exercise, which often include significant weight loss, low body weight, fatigue and injury.

In addition to evaluating how often and how hard one exercises, it's important to look at the underlying intention to determine if exercise is healthy or not. Exercise can be worrisome if driven by guilt or shame, a feeling of being out of control if one cannot engage in exercise behaviors, or the perception that exercise must be used to "make up for" eating or missing a workout session.

Compulsive exercisers can't go through a normal day without doing their exercise routine (or a comparable activity), and this need can interrupt normal life behaviors, including work, school or family commitments. Exercise consumes one's thoughts: People who struggle with unhealthy exercise behaviors are often incapable of having a conversation without talking about exercise.

Compulsive exercise is particularly common alongside an eating disorder. The perfectionistic temperament often seen in individuals with anorexia, bulimia and related disorders can also drive over-exercise behaviors as a compensatory mechanism for "getting rid of" calories and driving weight loss. When combined with depleted nutrition and medical complications characteristic of an eating disorder, over-exercise can be dangerous and physically compromise the body even further.

While some people may be able to overcome unhealthy exercise with the support of an outpatient psychiatrist, therapist or dietitian, others may need more intensive treatment. In general, treating compulsive exercise involves the following:

* Thorough medical, psychological and nutritional assessment. Compulsive exercise has both physical and emotional aspects that are unique to each person and should inform the individualized treatment plan. There are many times when individuals struggling with exercise or body issues are challenged with being able to reliably self-report. In these situations, a body-movement sensor can be helpful in establishing exercise patterns, including the frequency, volume or intensity of the movement.

* Stabilizing nutrition and interrupting exercise. This is important to determine metabolic function and, for individuals who are underweight, restore a healthy weight.

* Psychological support to explore contributing and maintaining factors of the over-exercise. I think back to one patient who, following interruption of her excessive exercise, said to me: "It was such a relief to be able to let go of the constant feeling that I had to get to the next level or reach the next goal. It felt like someone tapped me on the shoulder and said, 'It's OK, you've done enough, you can stop now.'" For some, permission to stop exercising and understanding how movement has been used to cope with painful feelings can be life changing.

* Identifying healthy movement versus over-exercise. Definitions of movement and exercise vary. For example, many of my patients may not consider walking, riding their bike or even doing stomach crunches to be exercise. They'll say this movement "doesn't count" because it's not part of their goal-based exercise. Understanding how the body supports movements of all kinds can help individuals understand healthy versus unhealthy movement.

* Identification of physical activities that the individual enjoys that uses their body. This could include walking with a friend, gardening, yoga and dance -- and adding in exercise/movement over time based on the individual's unique recovery needs. When reintroducing movement, exercise should not be about burning calories or creating a perfect body, it should be about the joy of movement.

Weight-loss resolutions at the start of the New Year can spiral from a simple exercise goal into unhealthy exercise compulsion, particularly among individuals with perfectionistic temperaments. Understanding that not all exercise is healthy is an important first step to growing awareness of the dangers of compulsive exercise. If you or someone you know is struggling with exercise behaviors, specialized treatment is available and lasting recovery is possible.

--Bonnie

Readers -- Do you know someone who is a compulsive exerciser? Have you ever had to stop yourself from exercising too much? What steps do you take to remind yourself that it’s OK to not exercise? Leave a comment below and let us know.

Bonnie Brennan, M.A., LPC, CEDS, is a licensed Professional Counselor and Certified Eating Disorders Specialist with over 20 years of experience in the treatment of eating disorders. She currently serves as senior clinical director of adult residential and partial hospitalization services at Denver-based Eating Recovery Center.

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